Deprivation, Importation, and Prison Suicide: The Combined Effects of Institutional Conditions and Inmate Composition

DEPRIVATION, IMPORTATION, AND PRISON SUICIDE: THE COMBINED EFFECTS OF INSTITUTIONAL CONDITIONS AND INMATE COMPOSITION

by

MEREDITH P. HUEY

(Under the Direction of Thomas L. McNulty) ABSTRACT

Previous research on suicide in U.S. prisons has focused the characteristics of inmates who commit suicide. These studies are largely descriptive, conducted within a single institution or department of correction, and overemphasize psychological explanations for suicide while ignoring the role of the prison environment. As a departure from prior research, this dissertation uses national data on 1,082 U.S. state prisons to examine how prison conditions, inmate

composition, and their interaction predict prison suicide. More theoretically, the dissertation tests the deprivation and importation models of prison suicide. These historically competing

perspectives respectively attribute suicide to either factors specific to the prison (deprivations) or characteristics that inmates bring with them (import) to prison. In testing these models, two analytic strategies are employed. First, prison suicide rates for each state are compared with the corresponding state rates for U.S. residents. Comparisons revealed that overall suicide rates in prison were slightly higher than those for the general community, but the difference was not statistically significant. Female inmate suicide rates, though, were substantially higher than the comparison rates for female U.S. residents (11.71 versus 5.03 per 100,000 population). Further analysis determined that prisons that experience female suicides were characterized by greater levels of deprivation (e.g., increased security levels, overcrowding, and violence) than those without suicide. In the second analytic approach, a series of negative binomial regression models are estimated, which capture the relative and combined effects of deprivation and importation indicators on the prison suicide count. The number of suicides was significantly increased in supermaximum and maximum security prisons (relative to minimum), under conditions of overcrowding and high levels of violence, and in prisons where a greater proportion of inmates received mental health services. Results of these analyses pointed to the combined effects of institutional conditions (security level, overcrowding, and violence) and inmate composition (mental health) on suicide. Deprivation variables were overwhelmingly predictive of suicide confirming the role of the prison environment in suicide. Theoretical and practical implications of these findings are discussed. Suggestions for future research on the topic are proposed.

INDEX WORDS: Prison, Suicide, Deprivation, Importation, Prison conditions, Census of

State and Federal Adult Correctional Facilities, Count Models

DEPRIVATION, IMPORTATION, AND PRISON SUICIDE: THE COMBINED EFFECTS OF INSTITUTIONAL CONDITIONS AND INMATE COMPOSITION

by

MEREDITH P. HUEY B.A., Erskine College, 1998

M.A., University of North Carolina, Greensboro, 2001

A Dissertation Submitted to the Graduate Faculty of The University of Georgia in Partial Fulfillment of the Requirements for the Degree

DOCTOR OF PHILOSOPHY

ATHENS, GEORGIA

2008

© 2008

Meredith P. Huey

All Rights Reserved

DEPRIVATION, IMPORTATION, AND PRISON SUICIDE: THE COMBINED EFFECTS OF INSTITUTIONAL CONDITIONS AND INMATE COMPOSITION

by

MEREDITH P. HUEY

Major Professor: Thomas L. McNulty Committee: Paul M. Roman

Ronald L. Simons

Electronic Version Approved:

Maureen Grasso

Dean of the Graduate School

The University of Georgia

August 2008

DEDICATION

I dedicate this dissertation to my daughter Piper Rae—just in case you ever wonder.

ACKNOWLEDGEMENTS

The completion of my dissertation would not have been possible without the assistance of my committee members and my friends and family. I would like to take this opportunity to acknowledge the unique contribution of each and to say a work of thanks.

First, I would like to acknowledge each of my committee members, Tom McNulty, Paul Roman, and Ron Simons. Tom advised me throughout my graduate career at UGA, co-authored my first published paper on prison suicide, supported me through the comps process, the

dissertation proposal and dissertation completion award, numerous presentations, and my job search. Thank you, Tom, for your feedback, your statistical know-how, and your willingness to work me. Paul, your research shop has been invaluable for my professional development. You, along with Aaron Johnson, Lori Ducharme, Hannah Knudsen, Sarah Henderson, the National Treatment Center Study and the Institute for Behavioral Research largely shaped my graduate career at the University of Georgia. Ron, it was in your classroom that I was most inspired to think critically about criminology. You always provided the encouragement I needed and as a result bolstered my confidence in my writing and research. Thank you all for your willingness to work with me on the dissertation project. You are all true academics and my professional role models.

I would also like to thank Jack Humphrey for his continued support and confidence in

me, Jennifer McMahon for listening and babysitting, April Brown for being there (literally, right

down the street) whenever I needed anything, and my dissertation support group, Liz, Abbi, and

Meredith Welch-Devine. In addition, I would like to thank my graduate coordinator, Jody Clay-

Warner. Jody, your guidance in Pro-Seminar and Job Market Seminar made the difference for me and I am sure for many others.

Finally, I must thank my friends and family who helped me see this through. First, Jerry Anne Cofer, you always had a word of encouragement for me that made me want to succeed.

You were there for me in a major way before and after Piper Rae entered my world. Next, my parents, Harry and Nancy Huey, my in-laws, Gary and Linda Dye, and my sister, Elizabeth Huey Moss—you all have supported me tremendously as I finished my dissertation, obtained a new job, had a baby, and moved to Tennessee. These life-changing events that most people

experience one at a time would not have happened all at once for me if you had not been there financially, emotionally, and spiritually. You drove many hours and miles to physically be with me when I needed anything. Daddy, you especially were there to watch Piper Rae when I needed to write, when I needed help moving, and when I needed you the most. I can’t thank you enough.

Lastly, my husband, Dwight, I don’t know where I would be without you. Your devotion to me

for the past seven year of marriage amazes me. I love you and will never take for granted how

truly blessed we are.

TABLE OF CONTENTS

Page

ACKNOWLEDGEMENTS... v

LIST OF TABLES ... ix

LIST OF FIGURES ... x

CHAPTER 1 INTRODUCTION ... 1

Motivations for Current Study ... 3

Contributions for Sociology and Criminology... 8

Organization of Chapters ... 10

2 THEORETICAL FRAMEWORK: INMATE ADAPTATION AND EXPLANTIONS FOR PRISON SUICIDE ... 11

Deprivation Model ... 12

Importation Model ... 25

Combined Model ... 32

Statement of Research Hypotheses ... 39

3 RESEARCH DESIGN & METHODS... 42

Data ... 42

Independent Variables ... 45

Analytic Strategy ... 49

4 COMPARISON OF PRISON AND U.S. SUICIDE RATES BY STATE ... 56

Prior Research ... 57

Data ... 61

Results... 62

5 RESULTS OF THE NEGATIVE BINOMIAL REGRESSION MODEL ... 72

Description of Prison Sample ... 72

Bivariate Results ... 75

Negative Binomial Regression Results ... 82

6 DISCUSSION & CONCLUSIONS ... 92

Summary of Empirical Findings: Implications for Theoretical Explanations for Prison Suicide ... 93

Implications for Penal Practice: Improving Prison Conditions and Preventing Suicide in Prison ... 99

Limitations of Findings... 103

Future Research ... 105

Conclusions ... 109

REFERENCES ... 111

APPENDICES ... 121

A Supplementary & Sensitivity Analyses ... 121

LIST OF TABLES

Page

Table 1.1 Suicide in State Prisons 2001 – 2005 ... 2

Table 3.1 CCF, 2000 Facilities: Distribution by Operational Authority and Primary Function ... 46

Table 4.1 Prison Suicide Rates Reported by Hayes and Mumola ... 60

Table 4.2 Comparison of Prison and State Suicide Rates ... 63

Table 4.3 Comparison of Prison and State Suicide Rates by Gender (Male)... 67

Table 4.4 Comparison of Prison and State Suicide Rates by Gender (Female) ... 68

Table 4.5 Female Inmate Suicide... 71

Table 5.1 Distribution of Prison Suicide Counts ... 72

Table 5.2 Descriptive Statistics ... 74

Table 5.3 Bivariate Correlations ... 76

Table 5.4 Bivariate Results ... 78

Table 5.5 Negative Binomial Regression Results Predicting Prison Suicide Counts... 83

Table 5.6 Discrete Changes in Expected Count of Suicide for Select Independent Variables ... 86

Table 5.7 Predicted Probability of Suicide Counts ... 87

Table 5.8 Predicted Probability of Suicide Counts ... 87

Table 5.9 Predicted Probability of Suicide Counts ... 91

Table 6.1 Deprivation, Importation, and Combined Models: Effects on Prison Suicide Counts .. 96

LIST OF FIGURES

Page Figure 1.1: Prison and U.S. Suicide Rates, 1980 – 2005 ... 2 Figure 5.1: Range of State Suicide Rates in Prisons with and without Suicide ... 81 Figure 5.2: Predicted Probability of No Suicide by Increasing Prison Assault Rates ... 89 Figure 5.3: Predicted Probability of No Suicide by Percentage of Inmates Receiving Mental

Health Services ... 90

CHAPTER ONE INTRODUCTION

Suicide in prison is a relatively rare event. Yet, rates of suicide are reportedly higher in prison than for the U.S. population in general. As shown in Table 1.1, the number of suicides in U.S. state prisons ranged from 168 in 2002 to 215 in 2005. Representing roughly six percent of all deaths in custody, suicide is currently ranked as the second leading cause of death in prison following only deaths due to natural causes.

According to a Bureau of Justice Statistics report (Mumola 2005), the rate of suicide per 100,000 inmates declined from 34 in 1980 to 16 in 1990, and has since remained fairly stable.

For the years 2001 to 2005, the suicide rate ranged from 14 to 17 suicides per 100,000 inmates (Mumola 2005). Figure 1.1 shows how the suicide rate for U.S. residents has consistently remained between 10 and 12 suicides per 100,000 population. In recent years, prison suicide rates—as shown in Figure 1.1—have been slightly higher than rates for the U.S. population.

The notion that rates of suicide are higher in prison than the general community implies that something specific to the prison—either the prison itself or the prisoners within—accounts for the elevated suicide rates. One objective of this dissertation is a comparison of suicide rates by state (chapter four). The primary purpose of this dissertation is to test two theoretical

explanations for prison suicide (chapter five). The deprivation perspective holds that prison

suicide is a product of the restrictive prison milieu. Loss of freedom, isolation, and conditions of

the prison increase the likelihood of suicide in prison. The importation model suggests that the

demographic, social, and psychological characteristics of inmates explain suicide. From this

perspective, predictors of suicide operate the same both in prison and in the general community.

Table 1.1 Suicide in State Prisons 2001 – 2005 Number of

Suicides

Rate (per 100,000 inmates)

Percentage of Deaths in

Custody

Rank

2001 169 14 5.9% 3 ^rd

2002 168 14 5.7% 3 ^rd

2003 200 16 6.3% 2 ^nd

2004 200 16 6.4% 2 ^nd

2005 215 17 6.8% 2 ^nd

Source: Deaths in Custody Reporting Program. Web Posted at http://www.ojp.usdoj.gov/bjs/dcrp/dictabs.htm

Figure 1.1 Prison and U.S. Suicide Rates 1980-2005

Source: Prison Rates from Deaths in Custody Reporting Program.

Web Posted at http://www.ojp.usdoj.gov/bjs/dcrp/dictabs.htm.

Source: U.S. Rates from Center for Disease Control and Prevention.

Web posted at http://www.cdc.gov/ncipc/wisqars/default.htm.

0 5 10 15 20 25 30 35 40

Prison Suicide Rate U.S. Suicide Rate

Using this theoretical framework, this dissertation addresses two research questions. 1) To what extent do prison conditions promote/restrict suicide? 2) In what ways do the characteristics of inmates predict prison suicide?

Motivations of Current Study

While documented cases of suicide in prison are certainly evident in the historical literature on the prison (Brockway 1969; Morris & Rothman 1995; Stern 1998), prison suicide research is a relatively young field of inquiry. Bruce Danto’s Jail House Blues (1973) represents the first serious attempt to understand prison suicide. This edited volume of writings by

concerned correctional psychologists, social workers, criminologists, and former inmates is a collection of the extant research on prison suicide available at that time. In addition to aiding the suicidal inmate, the contributing authors concerns were with the larger problem of the prison.

Twenty years after the publication of Jail House Blues, Danto published a second book on prison suicide with David Lester (Lester and Danto 1993). Suicide Behind Bars: Prediction and Prevention summarized the theoretical explanations for prison suicide (sociological and

psychological) as well as the extant research on the topic—a few dozen research articles on prison suicide were published in the 1980s and 1990s (Anno 1985; Anson 1983; Anson and Cole 1984; Batten 1992; Cox, Landsberg, & Paravati 1989; Haycock 1989; Haycock 1993; Hayes 1995; Jones 1986; Lester 1982; Lester 1987; O’Leary 1989; Rakis & Monroe 1989; Salive, Smith and Brewer 1989; and Sherman & Morschauser 1989). The text, however, focused on the prevention of suicide in prison and functioned as a “how to” guide for correctional officials.

Over the past four decades, scholarly interest in the topic of prison suicide has waxed and

waned, especially among researchers in the U.S. Following the 1980s and 1990s prisoner rights

and litigation movements, prisons came under attack from inmate interest groups, civilian

workers (i.e., psychologists, criminologists), and the courts as being inhumane, harmful, and not conducive to rehabilitation. Amid this era, professional organizations including that National Commission on Correctional Healthcare (NCCHC) and the American Correctional Association (ACA) developed standards of suicide prevention, which were adopted by many prison systems (Danto 1997; Hayes 1995; Hayes 1996). Since the year 2000, attention to the problem of prison suicide has grown (Daniel and Fleming 2006; He et al. 2001; Kovasznay et al. 2004; Way et al.

2005; White, Schimmel, and Frickey 2002). Again, however, most of the research is descriptive, psychological, focused on the inmate suicide profile, and geared toward prevention or protection from liability (Bonner 2000; and Hayes 1999). Indeed, research on prison suicide has been geared toward developing comprehensive suicide prevention programs that are “legally defensible” (Correia 2000).

Several themes emerge from these few decades of research on prison suicide. Most evident is the marked distinction between psychological and sociological approaches.

Psychological research dominates the field while sociological inquiry into prison suicide is under-developed (Liebling, Durie, Stiles, and Tait 2005). One result of this imbalance is that the bulk of the research consists of descriptions of a small group of inmates who committed suicide while incarcerated in a particular prison over a specified period of time. Some studies, but very few, include a comparison sample of inmates in custody during the same time frame who did not commit suicide or a comparison of the entire correctional population (Fruehwald et al. 2004;

Salive, Smith, & Brewer 1989; Way et al. 2005; and Winter 2000). A common finding in these

descriptive studies points to the mental health status of suicidal inmates, with the majority of

inmates who commit suicide in prison having been diagnosed with mental illness or having had

contact with mental health services while in prison (Daniel and Fleming 2006; He et al. 2001;

Kovasznay et al. 2004; Way et al. 2005; White, Schimmel, and Frickey 2002). Because the overwhelming majority of studies are conducted at the individual level of analysis (within a single institution/system), the data do not allow for an examination of the effect of prison conditions on suicide. A second theme is the extent to which prior studies tend to emphasize individual predictors of suicide and ignore the role of the prison context as explanations for suicide (for an exception see Wooldredge & Winfree 1992). Liebling (2006: 18) notes “the prison as an institution tends to get less attention from researchers than prisoners, so we know considerably more about the fates of ex-prisoners on release, for example, than we do about why suicides occur disproportionately in one prison rather than another.”

A third prevailing theme in the prison suicide literature is the assumption that prison suicide rates are higher than those in the general community. Researchers have compared prison and community suicide rates since the 1970s, but have reached different conclusions. Since the late 1980s, prison suicide researchers have reported declines in rates, which are attributed to the implementation of comprehensive suicide prevention programs (Hayes 1999; Bonner 2000;

Daniel 2006). Inconsistent findings could be the result of declining prison suicide rates, a pre- occupation with suicide prevention and deflecting attention away from the prison as a cause of suicide, a product of more sophisticated research methods, or a combination of these factors.

Whether suicide is more common in prison than the general community remains an empirical question.

Limitations of Prior Research & Contributions of Current Study

Due to the limited quantity of research on prison suicide, the available studies add valuable insight to the phenomenon. There are a few limitations of prior research, however.

Three are particularly relevant for the current study.

First, the best research on the topic of prison suicide comes from a few qualitative studies (Liebling 1992; Medlicott 2001). The findings from these studies have not been replicated using quantitative designs with larger and more varied samples of prisons and prisoners. Thus, the generalizability of the findings has not been substantiated.

Second, a large portion of the research is conducted in countries other than the U.S. For example, Allison Liebling’s (1992) qualitative research involves prisoners and prisons in the U.K. Well-designed studies have also been carried out in the Netherlands by Blaauw and colleagues, Austria (Freuhwald et al. 2004), Belgium (Snacken 2005), Canada (Wobeser et al.

2002) and Italy (Tatarelli et al. 1999). Differences in penal practices between countries including the separation of remand and sentenced prisoners make generalizing findings to the U.S.

problematic.

Third, studies conducted in U.S. prisons as a whole are theoretically and methodologically limited. The bulk of the research conducted in U.S. prisons is solely descriptive, correlational, and limited to small sample sizes within one prison or state prison system (Anno 1985; Daniel and Fleming 2006; Hayes 1995; Jones 1986; Kovasznay et al. 2004;

Salive, Smith, and Brewer 1989; Way et al. 2005; White, Schimmel, and Frickey 2002). Because most of the evaluations are prompted by the occurrence of suicide within an institution, the motivation is prevention and liability concerns rather than a fuller understanding of prison suicide. Consequently, these evaluations are often atheoretical (exception see Tartaro and Lester 2005).

Moreover, the methodological weaknesses of these studies often yield biased and

contradictory results that threaten reliability, validity and generalizability. In the past, studies

relied on descriptions of a small sample of suicide cases to produce prediction profiles that have

ultimately proved ineffective in preventing suicide (Kenney and Homant 1988). More recent studies have compared suicide cases with other samples of inmates who did not commit suicide or non-incarcerated populations including either suicide cases outside prison or characteristics of the U.S. resident population in general (Salive, Smith, and Brewer 1989; Kovasznay et al. 2004;

Way et al. 2005; White, Schimmel, and Frickey 2002). In two of the most recent evaluations, suicide cases were drawn from mental health treatment records and compared with the characteristics of the mental health caseload in that prison and the total inmate population for that state as well as suicide cases in other institutional settings (Kovasznay et al. 2004; Way et al.

2005). Data for these studies was extracted from the mental health records of completed suicides that occurred within the New York Department of Corrections between the years 1993 and 2002 (n=76). The suicides analyzed represented only 84% of the suicides that occurred during the time frame. Due to the selected source of data, the analyses could provide no information on the details of the suicide cases that did not have contact with prison mental health services. Thus, the exclusion of 16% of suicides without mental health records created a potential selection bias in the findings and doubt as to the relationship between mental health of inmates and suicide.

Studies are usually conducted within one prison or prison system (Anno 1985; Daniel and Fleming 2006; Jones 1986; Kovasznay et al. 2004; Salive, Smith, and Brewer 1989; Way et al.

2005). Given the nature of the data, these studies can rarely offer conclusions about the

relationship between the prison environment and suicide. In 1989, Salive, Smith, and Brewer

noted the importance of the prison context for understanding suicide by acknowledging the need

for larger, multivariate studies to analyze the separate effects of correctional characteristics. Over

a decade later, Way et al. (2005: 220) proposed that to better understand and prevent prison

suicide future work should focus on “incorporating long-term sentenced prison suicides from

many states and countries into a single data base with a standard format.” Despite these

conclusions, extremely few national evaluations of prison suicide in the U.S. are available (see Hayes 1995; Huey and McNulty 2005; Lester 1998; Mumola 2005; Tartaro and Lester 2005;

White, Schimmel, and Frickey 2002). None of these evaluations have considered both the individual (importation) and the institutional (deprivation) effects on prison suicide. As is the case with much of the research in U.S. prisons, the individual characteristics of inmate suicide cases have been overemphasized and role of the prison context has been ignored.

Motivated by the limits of prior research, the central purpose of the current study of prison suicide is test the deprivation, importation, and combined models of prison suicide using national survey data on prisons in the U.S. This study pays particular attention to the features of prison environment predictive of suicide, how the inmate composition of prisons is related to suicide, and the interaction of prison and prisoner characteristics on the likelihood of suicide.

Relatively little is know about why suicide occurs in some prisons but not in others and few studies have empirically considered the interaction of prison features and prisoner characteristics.

For these reasons, this study represents a major contribution to the research literature on prison suicide.

Contributions for Sociology and Criminology

This study of prison suicide also yields important contributions for the disciplines of sociology and criminology. Specifically, the research bridges the sociological perspective on suicide and the research on the effects of imprisonment. First, the sociological study of suicide is well established (Durkheim 1966; Stack 2000a and 2000b). Despite this long theoretical

tradition, the sociological study of suicide in prison is underdeveloped. That is, a limited number

of studies, which argue for the environmental causes of suicide, exist in the literature on prison

suicide. In contrast, psychological studies of prison suicide, which focus almost exclusively on the characteristics of individuals, are numerous. In addition, the prediction and prevention responses to prison suicide speak to the larger study of social control and the construction of social problems. A variety of stakeholders have vested interests in the control and even the definition of prison suicide as a problem. The way in which prison officials have responded to the ‘suicide problem’ with a ‘scientific’ psychiatric approach needs to be examined critically by sociologists (Conrad and Schneider 1992; Douglas 1967; Liebling 1992; Page 1994).

Second, an examination of the prison environment should be of interest to any sociologist or criminologist concerned with the effects of mass incarceration (Welch 1999; and Garland 2001a and 2001b). Research which attends to the effects of incarceration typically focuses on whether prison achieves its various purposes. Most of the research in this area is geared toward understanding post-incarceration recidivism and reentry after release rather than on the

correctional setting’s effect on inmates currently incarcerated (Hochstetler, Murphy, and Simons 2004; Mauer and Chesney-Lind 2002). The notion of whether prison is harmful is downplayed (Liebing and Maruna 2005; Tonry 2007; Welch 1999). Within the comparatively limited portion of research the majority of studies investigate the relationship between the incarceration

experience, prison conditions, and violence (against others) (Adams 1992; Berg and DeLisi 2006; Cao, Zhao, and Dine 1997; Ellis, Grasmick, and Gilmans 1974; Hochstetler and DeLisi 2005; Jiang and Fisher-Giorlando 2002; McCorkle, Miethe and Drass 1995). Suicide in prison (violence against self) is usually excluded from these analyses (Liebling, Durie, Stiles, and Tait 2005; for an example see Jiang and Fisher-Giorlando 2002; for an exception see Snacken 2005).

Therefore, this dissertation research fills an important gap in the existing literature on the effects

of incarceration.

Organization of Chapters

Chapter one has provided an introduction to the topic of prison suicide and outlined the study’s motivations, purpose and research questions, and contributions. Subsequent chapters of the dissertation are divided into theoretical and methodological components. Chapter two serves as the academic portion of the dissertation. Here, the theoretical framework for the current study is detailed and relevant research is reviewed. Chapter two concludes with a statement of the study’s research hypotheses.

Chapter three presents the study’s research design and methodology. The chapter begins with a description of the data used in the current study. The independent and control variables are then outlined followed by an explanation of the study’s analytic strategy.

The next two chapters are results chapters. In chapter four, prison suicide rates are

compared with U.S. suicide rates. Comparisons are made on both the national and state levels. In addition, rates are age adjusted for the age distribution of the prison population and analyzed separately for males and females. The rate comparisons provide some initial answers to the study’s research questions and implications for the deprivation and importation theories of prison suicide. Building on these findings, chapter five presents the results of the multivariate analysis, the Negative Binominal Regression Model (NBRM), which tests the theoretical explanations of prison suicide. The results of these models are preceded by a description of the sample including the key independent variables in the analysis as well as an examination of the bivariate

relationships between these variables and prison suicide.

The dissertation concludes with a discussion of the study’s empirical findings, theoretical

implications, and practical implications for suicide prevention. The final chapter also includes a

discussion of the limitations of the dissertation and directions for future research.

CHAPTER TWO

THEORETICAL FRAMEWORK:

INMATE ADAPTATION AND EXPLANATIONS FOR PRISON SUICIDE As outlined in chapter one, this study of prison suicide is guided by two research questions. The first question focuses on the role of the prison environment in prison suicide.

More precisely, to what extent do prison conditions promote (or restrict) suicide? Do features specific to the prison environment influence the likelihood of suicide behind bars? Further, do certain conditions have a greater impact on suicide than other conditions (e.g., isolation, security level, violence, and overcrowding)? The second question examines the relationship between inmate characteristics and suicide. To what extent do prisoner characteristics predict prison suicide? Are prisoners who commit suicide different from those who commit suicide in the community?

The questions guiding this dissertation research are informed by a larger theoretical debate within the criminological literature on how inmates adjust to life in prison—the

deprivation and importation models. These historically competing models respectively attribute

prison mal-adaptation (e.g., violence or suicide) to factors specific to the prison experience

(deprivations) or characteristics that inmates bring with them (import) into the prison. Despite

the focus on both individual and prison explanations for suicide, previous examinations of prison

suicide have rarely set out to directly test the deprivation and/or importation models. Rather,

studies have been implicitly organized by these theories (Hatty and Walker 1986). Within this

research, support is found for both models. As an explanation for prison suicide each model

contains a number of limits. Thus, contemporary prison suicide researchers stress the importance of integrated models, which focus on the interaction between inmates’ characteristics and the prison environment. The deprivation and importation models are seldom investigated together—

due primarily to data limitations—however, integrated models of prison suicide represent the most vital area of prison suicide research (Dear 2006; Liebling 1999; Liebling 2006; Towl, Snow, and McHugh 2001).

The goals of chapter two are to describe the deprivation and importation models in greater detail, to demonstrate how each perspective, singularly and in combination, is used to explain prison suicide, and to review the relevant research that explicitly/implicitly tests these models. The chapter concludes with a summary of this study’s objectives and contributions and a statement of research hypotheses.

Deprivation Model

The deprivation model is based on the classic work of Clemmer (1940), Sykes (1958), and Goffman (1961), and holds that mal-adaptation to prison (e.g., violence, aggression, anxiety, depression, distress, and suicide) is a product of the restrictive prison milieu. That is, depriving conditions of the prison produce aggressive or self-destructive behavior. Sykes (1958) coined the phrase “pains of imprisonment” to describe these conditions. He identified five specific

deprivations and suggested that inmates successfully adapt to these pains through inmate

solidarity and a system of inmate social roles. Clemmer (1940) described this process of

adaptation as “prisonization.” Goffman (1961) referred to the prison as a “total institution” and

detailed how inmates adapt to life in the total institution following a process of mortification or

changing of the self. In a more recent account of the modern prison, Farrington (1992) argued

that the prison is a “not-so-total” institution. Evidence of the “get tough” stance on crime and

punishment as well as the return to the total institution model witnessed in the supermax prisons, however, indicates a shift toward a more total prison. Farrington’s perspective along with the rise of the supermax prison illustrates how variations in levels of deprivation are directly related to inmate adaptation. The deprivations and inmate adaptations that correspond to each of these perspectives are presented in the following paragraphs.

Sykes’ Pains of Imprisonment

According to Sykes (1958: xiv), the “prison represents a social system in which an

attempt is made to create or maintain total or almost total social control.” This total control of the inmate is at the core of what Sykes refers as the “pains of imprisonment.” He identifies five pains or deprivations associated with prison life: deprivation of liberty, deprivation of goods and services, deprivation of heterosexual relationships, deprivation of autonomy, and deprivation of security.

The deprivation or loss of liberty is the most immediately obvious pain.

The prisoner must live in a world shrunk to thirteen and a half acres and within this restricted area his freedom of movement is further confined by a strict system of passes, the military formations in moving from one point within the institution to another, and the demand that he remain in his cell until given permission to do otherwise. In short, the prisoner’s loss of liberty is a double one—

first, by confinement to the institution and second, by confinement within the institution (Sykes 1958: 65).

Sykes (1958: 65) adds:

The mere fact that the individual’s movements are restricted,

however, is far less serious than the fact that imprisonment means

that the inmate is cut off from family, relatives, and friends …It is

not difficult to see this isolation as painfully depriving or

frustrating in terms of lost emotional relationships, of loneliness,

and boredom. But what makes this pain of imprisonment bite most

deeply is the fact that the confinement of the criminal represents a

deliberate, moral rejection of the criminal by the free community.

Thus, the loss of liberty consists not only of inmates’ confinement to the prison institution, but also to the restrictive conditions within the institution that ultimately isolate inmates from family, friends, and the outside. This isolation and rejection is a threat to inmates’ self-conception and must be “warded off, turned aside, rendered harmless” if the prisoner is to endure and adapt to prison life (Sykes 1958: 67).

The second pain, deprivation of goods and services, refers to the standard of living afforded to the inmate in prison. Here, Sykes refers to the prisoner’s basic material needs—the so-called necessities of life—as well as the amenities, however perceived by outsiders and inmates as “rightful.” This includes the basic needs of food, clothing, and shelter, opportunities for proper health and medical care including exercise, and material possessions including luxuries such as cigarettes and individual cell furnishings. In some situations, Sykes notes,

“inmates are better off in prison, in strictly material terms, than they could ever hope to be in the rough-and-tumble economic life of the free community” (68). However, “the average inmate finds himself in a harshly Spartan environment which he defines as painfully depriving” (Sykes 1958: 68).

Inmates are also deprived of heterosexual relationships. The privilege of conjugal visits is often denied. Visits with spouses and significant others take place under strict scrutiny of guards and usually occur through a plate glass window by means of face-to-face phone communication.

Lack of heterosexual relationships is described as psychologically and physically frustrating for

inmates. Overt homosexual threats as well as latent homosexual fears are realities in the life of

the inmate. For male inmates, Sykes notes that a man’s masculinity is called into question when

heterosexual relationships are denied.

Also called into question is the inmate’ status as adult versus child. The loss of autonomy an inmate experiences while in prison includes the inability to make choices and the ways their lives are totally and minutely controlled by a vast array of rules imposed by guards. These rules often do not “make sense” or are randomly enforced. As described by Sykes (1958: 73):

Most prisoners, in fact, experience an intense hostility against their far-reaching dependence on the decisions of their captors and the restricted ability to make choices must be included among the pains of imprisonment along with restrictions of physical liberty, the possession of goods and services, and heterosexual relationships.

For adult inmates, being thrust back into childhood dependency is frustrating. Because this loss of autonomy is imposed rather than freely granted, it is particularly painful and difficult to endure, and is another deprivation of prison life that inmates must adapt.

The last pain of imprisonment is the deprivation of security. The loss of security may include fear of physical aggression and exploitation of person or possessions, and may include threats to a prisoner’s reputation and level of respect. Sykes (1958: 77) observes:

There are a sufficient number of outlaws within this group of outlaws to deprive the average prisoner of that sense of security which comes from living among men who can be reasonably expected to abide by the rules of society.

Indeed, living with other criminals who are viewed as violent, dangerous, and out to prove their reputation for toughness is anxiety invoking. The prisoner must adapt to the loss of security or never feel safe living in prison.

Goffman’s Total Institution

Parallel to Sykes’ description of the pains of imprisonment is Goffman’s (1961) analysis

of the prison as a “total institution.” He defines the total institution as “a place of residence and

work where a large number of like-situated individuals, cut off from the wider society for an

appreciable period of time, together lead an enclosed, formally administered round of life”

(Goffman 1961: xiii). For Goffman, being “cut off from society” signifies the barriers between the institution and the outside world (i.e., locked doors, high walls, fences, and surveillance).

More importantly, Goffman emphasizes how the social organization of the total institution is incompatible with elements of the outside world including work and family structures.

In addition to being cut off from society, inmates lead a formally administered way of life. Within the total institution, inmates’ lives are carried out in the presence of other inmates as well as under the authority and surveillance of staff. All inmate activities are tightly scheduled and sequenced/enforced by the institution’s officials. The result of this formal round of life is an

“untraining” which renders the inmate incapable, if temporarily, of managing features common to life on the outside (Goffman 1961: 13). Writing of this loss of autonomy, Goffman (1961: 38) explains that:

By the time the individual is an adult he has incorporated socially acceptable standards for the performance of most of his activity, so that the issue of the correctness of his action arises only at certain points…Beyond this he is allowed to go at his own pace…In a total institution, however, minute segments of a person’s line of activity may be subjected to regulations and judgments by staff.

In essence, inmates are stripped of their former selves and are forced to take on the role of docile inmate (Foucault 1977). This isolation from the wider society and consequent loss of social roles brings about psychological stress, especially in cases of involuntary confinement such as the prison. In order to adjust to life in the total institution environment, inmates must manage this tension between the home world and the institutional world.

Farrington’s Not-so-Total Institution

As a direct challenge to Goffman’s (1961) notion of the prison as a “total institution,”

Farrington (1992) and others (Jacobs 1977; McCorkle, Miethe, and Drass 1995; and Berg and

DeLisi 2006) describe the modern prison as “not-so-total.” In essence, prisons and inmates are not as “cut off from society” as Goffman’s ideal type suggests. Berg and DeLisi (2006:633) explain:

Prisons are no longer ‘total institutions’ whose walls wholly isolate inmates from the community. Instead, the barriers between community and prison are porous and permit considerable transference of behaviors that influence inmate conduct.

Farrington (1992) points to several logical obstacles to the operation of the total institution model for the modern prison. These logical problems support the central thesis on why “the modern prison is not as completely or effectively ‘cut off from the wider society’ as Goffman’s description” (Farrington 1992: 6). According to Farrington (1992: 113), the “most significant violations of the truly total institutional concept in the modern prison is the fact that those who work there tend to move with great freedom and regularity between it and the outside world.” To be truly total, prison staff would also be separated from the outside world and the penal institution would be generally self-sufficient. In reality, institutional needs of the modern prison (e.g., food, clothing, work, education, and healthcare) are met with outside assistance from manufacturers, administrators, experts, and professionals.

Likewise, prisoners may be separated by walls, bars, and razor wire fences, but most modern prisons allow visitation between inmates and friends and family as well as contact with the outside world via letters, news, and telephone communication. Even among somewhat total institutions, prisoners are removed from society for only a short period of time and then

reintegrated back into society. Contact with the outside community through work release and furloughs are used to prepare inmates for reintegration in some prisons.

Prison placement is another basic obstacle to the notion of the total institution. A

common strategy is to site prisons in remote areas to ensure some amount of isolation. Even still,

prisons are located within urban and rural host communities rather than exiled to far removed locations. Prisons and communities develop a functional interdependence and connectedness (e.g., political, economic, and social) that limits the prison from being truly total.

Re-emergence of the Total Institution: Supermax Prisons

Farrington’s (1992) description of the “not-so-total institution” co-exists with the “get tough” on crime and punishment measures of the past several decades. During this era, the U.S.

embarked on a campaign of mass incarceration resulting in the imprisonment of nearly 2 million U.S. citizens. A hallmark of this era and an equally tough response to crime and punishment has been the emergence of the supermaximum security prison. Since the 1990s, approximately forty states in the U.S. have constructed these institutions to house inmates too violent for the general population of maximum security prisons and those inmates who represent a threat to guards and other prisoners (King 2006). In addition, most prisons have designated secure housing units (SHU) or administrative segregation cells with conditions similar to the supermax. It is estimated that approximately 20,000 inmates or 2% of the inmate population in the U.S. are housed in these institutions and units (King 2006).

Characterized by solitary confinement and deprivation, these facilities are reserved for the “the worst of the worst” inmates, the prisoners that society wants to punish the most. Inmates are confined to single, isolated cells for 23 hours per day with no contact with other inmates. Out of cell activities including exercise and hygiene routines are also solitary. In addition to the solitary nature of confinement, inmates’ lives are highly regulated. Contact with friends and family via visits, phone calls, and mail is tightly controlled and limited as is contact with guards.

Guards monitor inmates through video surveillance and communicate through speakers and

microphones. When out of their cells, inmates are escorted in shackles, bound at the hands, feet,

and waist, and often wear face shields. Guards wear protective clothing and gloves during escorts which further reduces one-on-one contact with inmates. Each time an inmate leaves or returns to a cell, a strip search is performed. Personal items including books, pens, and televisions are restricted or prohibited, and if available are controlled by the guards (King 2005).

Supermax prisons are purposefully depriving. The conditions of these institutions can be described as nothing less than total. Thus, the rise of the supermax prison represents a re-

emergence of the total institution model where inmates are “cut off from society” as well as isolated from each other.

Modes of Adaptation

Contemporary prisons in the U.S. range in the levels of deprivation as evidenced by Farrington’s (1992) description of the “not-so-total institution” as well as the increased use of supermaximum security units and prisons. The ways inmates adapt to these conditions also varies. Deprivations may increase individual opposition (i.e., violence or suicide) or produce inmate solidarity and the development of an inmate subculture. Both Sykes (1958) and Goffman (1961) expound upon the different modes of adaptation.

According to Sykes (1958), in order to alleviate the “pains of imprisonment” inmates develop their own social structure, which includes corresponding norms and values (inmate code), language (argot), and social roles. This inmate social system is rooted in solidarity among inmates and antagonism towards guards. Through the process of “prisonization” (Clemmer 1940), inmates assimilate into the culture of the penitentiary in order to alleviate the “pains of imprisonment.”

While Sykes’ (1958) primary interest is how inmates relieve the “pains of imprisonment”

through the development of inmate solidarity, he acknowledges that, in rare instances, inmates

demonstrate other reactions to life in prison. Inmates may attempt to physically escape from prison. In addition, inmates may escape psychologically by withdrawing from the goals, drives, and needs common to most inmates. Lastly, inmates may attempt to “overthrow or change the custodial regime to ease the frustrations and deprivations which plague them” (Sykes 1958: 80- 81). This could be a forceful rebellion or a peaceful persuasion for change. Sykes emphasizes, however, that inmates are rarely capable of successfully implementing these modes of adaption.

Goffman (1961) also describes how inmates adapt to life in total institutions. Upon entering the prison, inmates are stripped of their personal, pre-prison characteristics via degradation and mortification rituals, and become institutionalized. A new “self” develops through interaction with other people in the prison (inmates and guards) as well as through daily rituals of the institution.

For Goffman, the ways inmates adapt or “do time” in the institution varies. At the extremes, inmates may either become completely immersed in or alternately withdraw

from/challenge the institution in order to adapt. For example, through a process of “colonization”

inmates lead a relatively contented existence within the institution by focusing on the desirability of life inside the institution relative to life on the outside. A similar form of adaptation is

“conversion.” Here, inmates act out the role of the perfect inmate. In contrast to these modes of adaptation, inmates may “situationally withdraw” from involvement in everyday events of the institution. Goffman relates this to “prison psychosis.” In other cases, inmates may challenge the formal institution and refuse to follow the rules of the regime. Most inmates, he notes “play it cool” in order to maximize the chance of getting out of the institution physically and

psychologically intact.

Although Sykes and Goffman identify different modes of adaptation, their analyses of inmate adjustment result in three essential types. As outlined by Matthews (1999: 55), these types include:

1. Co-operation or colonization. In this mode of adaptation prisoners will aim to keep out of trouble and do their time with the minimum degree of conflict and stress, and with the intention of working towards their earliest release date.

2. Withdrawal. This can take a number of different forms, including physical separation from other inmates, engaging in minimum degrees of communication, depression, or self-mutilation and suicide.

3. Rebellion and resistance. This may involve engaging in riots or disturbances at one extreme, and forms of non-cooperation at the other. The form which rebellion or resistance takes will depend upon the pressures placed on offenders, their background and experiences and the extent to which they feel that their confinement or treatment in prison is fair and just.

Sykes and Goffman emphasize the first type of adaptation (co-operation). Much of the literature which tests the deprivation model of inmate adaptation examines the final mode of adaptation (i.e., violence and prison disturbances) (for example, Berg and DeLisi 2006; Cao, Zhao, and Dine 1997; Grasmick and Gilman 1974; Hochstetler and DeLisi 2005; Jiang and Fisher-

Giorlando 2002; McCorkle, Miethe and Drass 1995). Withdrawal as a form of (mal-) adaptation, and in particular prison suicide, has received relatively little attention, theoretically or

empirically. Drawing on the available prison suicide research, the following section evidences the ways in which the deprivation model of inmate adjustment applies to suicide in prison.

Application to Prison Suicide

In the case of prison suicide, the greater the levels of deprivation or the more total a

prison institution, the greater the likelihood of suicide in prison. Because prisons vary in levels of

deprivation, “confinement is not everywhere equally suicidogenic” (Haycock 1993:129). With

suicides reported in only 10-15% of U.S. prisons each year, it is evident that most prisons do not experience suicide (Huey and McNulty 2005). Certain conditions of the prison environment including security level, isolation within the institution, contact with others outside the institution, overcrowding, program availability, and levels of violence and safety tend to influence the likelihood of suicide.

Research suggests that suicides occur more often in maximum compared to medium and minimum security prisons, where deprivations are greatest (Daniel and Fleming 2006; Huey and McNulty 2005; Salive, Smith, and Brewer 1989; Way et al. 2005). Way et al. (2005) reported that 83% of suicides in the New York Department of Corrections between 1993 and 2001 occurred in maximum security settings. In a study of the effects of institutional conditions and prison suicide, Huey and McNulty (2005) found security level to be the strongest predictor with maximum and medium security prisons, respectively, 7.5 and 4.5 times more likely to experience suicide than minimum security counterparts. The relationship between supermaximum security prisons and suicide has not been empirically established, but anecdotal accounts suggests that increased levels of psychological harm and distress are reported among inmates living the depriving conditions of the supermax (Johnson 2005; King 2005 and 2006). In particular, placement in a single cell or other segregated housing unit similar to those used in supermax prisons, is shown to increase the likelihood of suicide (Freuwald et al. 2002; and Freuwald et al.

2004; Way et al. 2005).

Moreover, researchers consistently point to isolation as a major risk factor for suicide in

prison (Hayes 1995). Evaluations of suicide cases in prison suggest that the overwhelming

majority of suicides are housed in single cells. Anno (1985) concluded that 97% of inmates who

committed suicide were housed in single cells. More recent evaluations indicate that

approximately 60% of inmates who commit suicide are housed in single cells, nearly half of which are described as administrative segregation or punitive housing (Daniel and Fleming 2006). In addition, prisons in which inmates are held in single cells are significantly more likely to experience a suicide compared to those in which inmates reside in dormitory style housing (Huey and McNulty 2005).

In some prisons, inmates participate in community work release programs or are allowed weekend furloughs, family visits, and additional opportunities for contact with the outside community. By maintaining extra-prison social bonds, this relationship between prison and community, in turn, affects suicide in prison, with “not-so-total” institutions experiencing less suicide. Liebling’s (1992) qualitative interviews with suicide attempters in U.K. prisons indicate that prisoner’s vulnerability to suicide is related to family and outside contact. Prisoners

vulnerable to suicide have few or unreliable visits, write few letters, have little contact with community release/probation programs, and find thinking of the outside difficult. The extent to which community release programs create a buffer for prison suicide is not yet clear. However, descriptive studies that report the location of suicides in custody indicate that only 3% of

suicides occur outside of the facility while inmates are on work details, on work release, or under community supervision (Mumola 2005). Participation in community/work release programs may similarly decrease the likelihood of suicide as participation in in-prison vocational, education, and psychological programs (Huey and McNulty 2005).

Another aspect of deprivation is the extent to which prison facilities provide inmates with

access to rehabilitation and similar programs. Suicide may be more likely in prison environments

that lack or provide limited access to educational and vocational programs while prisons in

which larger percentages of inmates participate in such programs evidence significantly lower

odds of suicide (Huey and McNulty 2005; Kupers 1999). Additionally, several qualitative studies suggest that the ways in which inmates “do time” are also associated with suicide (Liebling 1992; Matthews 2000; Medlicott 2001). For some prisoners, the subjective experience of passing time in prison is painful. Medlicott (2001) found that empty time was particularly painful for suicidal prisoners. Liebling (1992; 1999) concluded that the use of time and opportunities accounted for much of the difference between suicide attempters and other prisoners, with inactivity the central variable in the context of prison suicide.

Overcrowded prison conditions also contribute to the pains of imprisonment. It is widely assumed in the literature—reinforced through court decisions—that overcrowding exerts

deleterious effects on inmates’ psychological and behavioral well-being. Evaluations of the effects of overcrowding on prison suicide have produced somewhat mixed results (Gaes 1992;

Liebling 1992). Due to the use of different measures and definitions of overcrowding,

researchers have reached different conclusions as to the effects on suicide. In an evaluation of

527 U.S. prisons, Innes (1987) found that as the inmate population increases, the number of

suicides increased. Cox et al. (1984) examined prison suicide rates in Illinois, Mississippi,

Oklahoma, and Texas prison systems and found that as the inmate population increased, the rate

of suicide increased three times more. Overcrowding as measured by prison size, rated capacity,

and inmate to staff ratio evidenced a pronounced effect on suicide in U.S. prisons (Huey and

McNulty 2005). In this study, conditions that would normally buffer against suicide such as

lower security levels were erased under conditions of high overcrowding. Minimum security

facilities were as likely to experience suicide as maximum and medium security counterparts at

high levels of overcrowding. The relationship between court orders to reduce inmate counts and

prison suicide has received little empirical attention. One study, however, found the presence of

court orders to reduce overcrowding to be related to decreased rates of suicides in prisons (Cox et al. 1984).

While prison violence in general has not been directly linked to suicide in prison, the levels of violence and fears for safety are for some inmates a paramount component of the pains of imprisonment. Suicides in prison are often preceded by stressors such as bullying, violence, and prison rape (Blaauw, Winkel, and Kerkhof 2001; Lester and Danto 1993; Liebing 1992).

Half of the inmate suicide cases in New York State Correctional Facilities between 1993 and 2001 were preceded by recent inmate-to-inmate conflict while nearly half (42%) of these cases had received disciplinary action (Kovasznay et al 200). Likewise, for federal inmates, inmate- related conflicts were noted among the precipitating factors for suicide (White, Schimmel and Frickey 2002).

Importation Model

In contrast to the deprivation perspective, the importation model attributes mal-adaptation to the characteristics of inmates rather than features specific to the prison environment.

Proponents of the importation hypothesis (Irwin and Cressey 1962) criticize the deprivation model as being overly narrow and ignoring the characteristics of inmates, which largely

determine behavior in prison. According to Irwin and Cressey (196:145) “a clear understanding

of inmate conduct cannot be obtained simply by viewing ‘prison culture’ or ‘inmate culture’ as

an isolated system springing solely from the conditions of imprisonment.” External behavior

patterns and values are instead imported into the prison from the outside. The “convict code” as

suggested by Clemmer (1940) and Sykes (1958) is better characterized by the “code of the

street” (Anderson 1998; Wacquant 2001). Characteristics as well as norms and values facilitate

inmate adjustment to prison for certain groups of inmates (Carroll 1974; Jacobs 1974 and 1977;

Wacquant 2001).

Application to Prison Suicide

As an explanation for prison suicide, the importation perspective suggests that inmates’

demographic, social, and psychological characteristics rather than prison conditions best explain suicide in prison. For importation theorists, prison represents an opportunity for suicide rather than its cause (Kennedy and Homant 1988). Supporting this notion, research indicates that risk factors associated with suicide in non-incarcerated populations including mental health issues, previous trauma, prior suicide attempts, and substance abuse problems as well as demographic correlates (e.g., gender, age, and race) are prevalent among suicide cases in prison as well as the prison population as a whole (Kovasznay et al. 2004; Mumola 2005; Way et al. 2005). Prisoners are designated as a high suicide risk group (WHO 2000) and are described as suicide prone and carefully selected to be at risk of suicide (Liebing 1992: 68).

Gender and Prison Suicide. As is the case for U.S. residents in general, and as a reflection of the U.S. prison system, which is disproportionately male, most suicides in prison involve male inmates. Consequently, prior research on prison suicide has focused almost exclusively on male suicide cases or male-only prisons (Lester and Danto 1993; Salive, Smith, and Brewer 1989;

White, Schimmel, and Frickey 2002). Based upon the assumption that female inmates are under- represented among prison suicides, suicide in prison has been viewed as a problem that only affects male inmates (Liebling 1999; Themeli 2006). As the population of female inmates and prisons has increased, however, more attention has been geared toward understanding the relationship between gender and prison suicide. Way et al. (2005) reported that 4% of the

suicides completed between 1993 and 2002 in New York State prisons involved female inmates,

which was similar in proportion to the total female inmate population in that state. In Mumola’s (2005) report on suicide in U.S. state prisons during 2001-2002, male and female inmate suicide rates were similar. At a rate of 14 per 100,000 inmates, male inmates were slightly more likely to commit suicide than females (10 per 100,000).

Men in general commit suicide at a rate of two to four times higher than women (WHO 2004). The similarity in prison suicide rates for males and females differs from suicide rates reported for male and female U.S. residents (17.6 versus 4.1 suicides per 100,000 residents respectively in 1999) (see also Way et al. 2005). This discrepancy in rates has received little research attention by importation theorists, but requires explanation (for an exception see

Liebling 1999; Themeli 2006). The gender-suicide relationship is considered in more depth later in this chapter.

Age and Prison Suicide. Regarding the relationship between age and suicide, summary statistics for U.S. residents indicate that suicide mortality increases with age (WHO 2004). In U.S. prisons, this trend has not been confirmed (Kovasznay et al. 2004). Mumola (2005) reported that inmate age was not related to prison suicide rates for the years 2001-2002. Across all age groups (18 to 55 and older), rates consistently ranged from 13 to 14 suicides per 100,000

inmates. White, Schimmel, and Frickey (2002) also found no consistent age trend among suicide cases over a fifteen year timeframe. ¹

Prison suicide profiles point to younger offenders as being at the greatest risk of suicide in prison (Lester and Danto 1993; Liebling 1999). Studies indicate that inmates who commit suicide are on average younger than the general prison population as well as the U.S. resident

1 Studies of prison suicide in other countries reveal a different age-suicide relationship, with

older inmates over-represented among suicide cases (Blaauw, Kerkhof, and Hayes 2005; Blaauw

and Kerkhof 2006).

population. Comparing 76 suicides that had mental health services contact with the overall prison mental health caseload and the New York Department of Corrections population, Way et al.

(2005) found that the suicide group was significantly younger than the comparison groups (32.8 years versus 37.1 and 34. 6 years respectively). Nearly half (47%) of the suicide cases were between the ages of 25 and 34. In a study of Maryland prisons, Salive, Smith, and Brewer (1989) reported a similar age distribution. In this study, the mean age of suicide cases was 29.3 years (SD=6 years) and the highest suicide rates were for those ages 25 to 34. Of the 337 suicides that took place in U.S. state prisons during the years 2001-2002, 116 suicides (34.4%) were among prisoners age 25 to 34 (Mumola 2005).

Recent research attention has focused on suicide among juveniles in custody (see Hayes 2004). Suicide represents the leading cause of death in juvenile correctional facilities (Roberts and Bender 2007). Suicide rates in these facilities are estimated at more than four times the rates of juveniles in the U.S. (Hayes 2004; Memory 1989). For inmates under the age of 18, the rate of suicide in adult prisons is 52 per 100,000, which is four times higher than other inmate age groups (Mumola 2005).

Race and Prison Suicide. The over-representation of white inmates and under-

representation of black and Hispanic inmates in prison suicide estimates is consistently reported

in the literature on prison suicide (see Anno 1985; Anson 1983; Anson and Cole 1984; Daniel

and Fleming 2006; Danto 1973; He et al. 2001; Kovasznay et al 2004; Salive, Smith, and Brewer

1989; Way et al. 2005; White, Schimmel, and Frickey 2002). For example, the racial disparities

in inmate suicide are evident in the New York Department of Corrections for the years 1993 to

2001. During this time, white inmates accounted for 37% of inmate suicides, but only 18% of the

total inmate population (Way et al. 2005). The most recent U.S. state prison estimates indicate that for the years 2001-2002:

White inmates had the highest suicide rate of all State prisoners (22 suicides per 100,000 inmates). This rate was 22% higher than the Hispanic suicide rate (18 per 100,000)…Black inmates had the lowest suicide rate of all State prisoners (8 per 100,000). Blacks were about a third as likely as white to commit suicide in State prison and less than half as likely as Hispanics (Mumola 2005: 6).

Compared to other racial and ethnic minorities, suicides are more prevalent among white inmates and U.S. residents alike (Anson and Cole 1984; Salive, Smith, and Brewer 1989). Anson and Cole (1984) examined the racial differences in inmate suicidal behavior in the Florida prison system for a five year reporting period. Their findings indicated that, relative to black inmates, suicides committed by white inmates exceed the proportion of white inmates in the prison population. Because whites are also significantly more likely to commit suicide than blacks in the free-world, Anson and Cole (1984) argued that the findings supported the importation model of prison suicide. They concluded that the relationship between race and suicidal behavior observed within the prison “is a reflection of the same demographic forces operating on the outside. It follows from this that racial differences in the prison experience are best explained by pre-prison experiences or processes” (Anson and Cole 1984: 555). Using a similar rationale, Haycock (1989) suggested that the lower rate of suicide for black inmates simply conforms to the racial differences in suicide rates within the community (see also Lester and Danto 1993).

Mental Health, Psychiatric Diagnoses, and Prison Suicide. The psychological make-up, mental illness, and psychiatric impairment of prison suicide cases is well-documented in the literature on inmate suicide (Anno 1985; Bland et al. 1990; Bonner 2006; Cox 2003; Dooley 1990; Fogel 1992; Green et al. 1993; Ivanoff 1992; Ivanoff and Jang 1991; Jones 1986;

Kovasznay et al. 2004; Skegg and Cox 1991; Smyth and Ivanoff 1994; Tatarelli et al. 1999; Way

et al. 2005; White, Schimmel, and Frickey 2002). Using a case-control design to compare suicide cases in custody with a similarly matched group of inmates, Fruehwald et al. (2004) reported that psychiatric diagnoses were one of the most important predictors of suicide among sentenced prisoners. ² Studies report that 25% to 35% of inmates suicide cases are diagnosed with a

psychotic disorder such as schizophrenia (Daniel and Fleming 2006; Kovasznay et al. 2004; Way et al. 2005; White, Schimmel, and Frickey 2002). In addition, mood/affective disorders,

personality disorders, adjustment disorders, and substance-related disorders are prevalent among inmate suicide cases (Daniel and Fleming 2006).

Indeed, mental health and psychiatric diagnoses including psychotic disorders, anxiety, depression, drug and alcohol dependence/ abuse, and prior suicide attempts are the most common correlates of suicide for both non-incarcerated and prison populations (Tripodi and Bender 2008). However, prisoners in general evidence an elevated risk of these disorders, which makes prediction and screening for suicide potential based upon mental health indicators difficult (Blaauw and Kerkhof 2006; Liebling 2001; Medlicott 2001). Most suicide evaluations (i.e., mortality reviews and psychological autopsies) find that the eventual suicide cases were judged as low or undetected for risk of suicide based on symptoms of mental illness during incarceration and at the time of the suicide (Sanchez 1999; Tartarelli et al. 1999; Way et al. 2005). Although inmate suicide cases evidence a number of mental health issues, the proportion of cases with documented mental health diagnoses is low compared with that of the total prison population and with suicide cases that do not take place in custody. When Way et al. (2005) compared suicide cases to the mental health caseload and estimates for the non-incarcerated population the results indicated that diagnoses for schizophrenia were similar in proportion to the caseload group

2 Inmates were matched on time of admission, demographic characteristics, custodial institution,

and custodial status.